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Health-promoting behaviours and concussion history are associated with cognitive function, mood-related symptoms and emotional–behavioural dyscontrol in former NFL players: an NFL-LONG Study
  1. Samuel R Walton1,
  2. Zachary Y Kerr1,
  3. Benjamin L Brett2,
  4. Avinash Chandran1,3,
  5. J D DeFreese1,
  6. Abbie E Smith-Ryan1,
  7. Lee Stoner1,
  8. Ruben J Echemendia4,5,
  9. Michael McCrea2,
  10. William P Meehan, III6,7,
  11. Kevin M Guskiewicz1
  1. 1 Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  2. 2 Neurosurgery/Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  3. 3 NCAA Injury Surveillance Program, Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
  4. 4 Psychology, University of Missouri Kansas City, Kansas City, Missouri, USA
  5. 5 Neuropsychology, University Orthopedics Center Concussion Clinic, State College, PA, USA
  6. 6 Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
  7. 7 Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Zachary Y Kerr, Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; zkerr{at}email.unc.edu

Abstract

Objectives To examine the relationships among self-reported sport-related concussion (SRC) history and current health-promoting behaviours (exercise frequency, diet quality and sleep duration) with self-reported measures of brain health (cognitive function, symptoms of depression and anxiety and emotional–behavioural dyscontrol) in former NFL players.

Methods In this cross-sectional study, a questionnaire was sent to former NFL players. Respondents reported SRC history (categorical: 0; 1–2; 3–5; 6–9; 10+ concussions), number of moderate-to-vigorous aerobic and resistance exercise sessions per week, diet quality (Rapid Eating Assessment for Participants—Shortened) and average nightly sleep duration. Outcomes were Patient-Reported Outcomes Measurement Information System Cognitive Function, Depression, and Anxiety, and Neuro-QoL Emotional-Behavioral Dyscontrol domain T-scores. Multivariable linear regression models were fit for each outcome with SRC history, exercise frequency, diet quality and sleep duration as explanatory variables alongside select covariates.

Results Multivariable regression models (n=1784) explained approximately 33%–38% of the variance in each outcome. For all outcomes, SRC history (0.144≤|β|≤0.217) was associated with poorer functioning, while exercise frequency (0.064≤|β|≤0.088) and diet quality (0.057≤|β|≤0.086) were associated with better functioning. Sleeping under 6 hours per night (0.061≤|β|≤0.093) was associated with worse depressive symptoms, anxiety and emotional–behavioural dyscontrol.

Conclusion Several variables appear to be associated with mood and perceived cognitive function in former NFL players. SRC history is non-modifiable in former athletes; however, the effects of increasing postplaying career exercise frequency, making dietary improvements, and obtaining adequate sleep represent important potential opportunities for preventative and therapeutic interventions.

  • concussion
  • american football
  • diet
  • exercise
  • Sleep

Data availability statement

The data from this survey study are available upon reasonable request. Inquiries may be sent to Dr ZYK.

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Data availability statement

The data from this survey study are available upon reasonable request. Inquiries may be sent to Dr ZYK.

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Footnotes

  • Twitter @SammoWalton, @BenjaminBrett1

  • Contributors All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Specific author contributions are as follows: SRW, ZYK, BLB and AC: creation and distribution of the study survey, management of study database, established research hypotheses, planned analyses of the data, interpretation of study findings, manuscript preparation and revision, final approval of the submitted manuscript. JDDF, AES-R, LS, RJE, MM, WPM III and KMG: creation and distribution of the study survey, interpretation of study findings, manuscript preparation and revision, final approval of the submitted manuscript. Other contributors to the project are as follows (included in acknowledgements): Mrs CG, Project Administrator: Assisted in the creation and distribution of the survey instrument as well as collection and management of the survey responses. Additionally, she was responsible for overseeing the project administration and execution. Ms HC, Project Coordinator (Medical College of Wisconsin): Assisted in the creation and distribution of the survey instrument as well as collection and management of the survey responses. Additionally, she assisted with oversight of the project administration and execution. Ms. Caprice Hunt, Project Coordinator (University of North Carolina at Chapel Hill): Assisted in the creation and distribution of the survey, oversight of the project administration, and execution of the study.

  • Funding Funding for this research project comes from the National Football League and Boston Children’s Hospital.

  • Competing interests BLB acknowledges support from the National Institute of Neurological Disorders and Stroke under the National Institutes of Health under the award NO L301L30NS113158-01. RJE is a paid consultant for the NHL and co-chair of the NHL/NHLPA Concussion Subcommittee. He is also a paid consultant for Major League Soccer and Princeton University Athletic Medicine and occasionally provides expert testimony in matters related to MTBI and sports concussion. WPM receives royalties from 1) ABC-Clio publishing for the sale of his books, Kids, Sports, and Concussion: A guide for coaches and parents, and Concussions; 2) Springer International for the book Head and Neck Injuries in Young Athlete and 3) Wolters Kluwer for working as an author for UpToDate. His research is funded, in part, by philanthropic support from the National Hockey League Alumni Association through the Corey C. Griffin Pro-Am Tournament and a grant from the National Football League.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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